A Low-Cost Facial and Dental Nerve Regional Anesthesia Task Trainer

Audience This facial and dental regional anesthesia task trainer is designed for teaching emergency medicine (EM) residents and medical students; however, it can be used by other specialties including plastic surgery, otolaryngology, oral surgery, and dentistry. Introduction While the opioid epidemic remains a public health crisis, emergency departments (EDs) continue to treat patients who require painful facial procedures or who present with severe dental pain. There is increasing interest and renewed use of regional anesthesia for procedural anesthesia and as an effective non-opioid analgesic. Although many nerve blocks are now being taught using ultrasound guidance, regional anesthesia of the face and mouth is still performed using landmark-based techniques. To date, there are no commercially available task trainers for teaching regional anesthesia of the face and mouth. Therefore, a low-cost, feedback-enhanced, partial task trainer was created for teaching regional anesthesia of the supraorbital, infra-orbital, mental, and inferior alveolar nerves. Educational Objectives By the end of this educational session, learners should be able to: Describe and identify relevant anatomy for supra-orbital, infra-orbital, mental, and inferior alveolar nerves. Successfully demonstrate supra-orbital, infra-orbital, mental, and inferior alveolar nerve blocks using a partial task trainer. Educational Methods Using inexpensive and commonly found materials, we were able to successfully modify an existing airway task trainer in order to create a feedback-enhanced partial task trainer for teaching supra-orbital, infra-orbital, mental, and inferior alveolar regional anesthesia. When the needle is inserted in the correct nerve location by the learner, the task trainer provides positive feedback in the form of an audible alert. This innovative task trainer has been used to teach post graduate year (PGY) 1–4 resident learners as part of a standard emergency medicine residency didactics curriculum. After a brief introductory didactic session, participants are given the opportunity for hands-on skills practice using the task trainer under faculty supervision. Research Methods An existing airway task trainer was successfully modified in order to create a feedback-enhanced, partial task trainer for teaching supra-orbital, infra-orbital, mental, and inferior alveolar regional anesthesia. Learners were asked to complete a post-session survey to assess the educational value of the station and the task trainer. Results Twenty-one residents (10 PGY-1, 9 PGY-3, 2 PGY-4) participated in a didactic session and all completed a brief post-session survey. Many participants (N=10, 48%) had never previously performed any of these nerve blocks. On average, participants rated their comfort performing these specific nerve blocks before the session to be 1.96 on a 5-point Likert-scale (where 1=not at all comfortable and 5=extremely comfortable). Following the session, participants’ comfort level increased to 3.67 on the same scale. Participants rated the usefulness of the feedback-enhanced task trainer to be a 4.71 on a 5-point scale (where 1=not at all useful and 5=extremely useful). Discussion Using inexpensive and commonly available materials, we were able to successfully modify an existing airway task trainer in order to create a feedback-enhanced partial task trainer for teaching regional anesthesia of the face and mouth. Learners reported that the educational session greatly increased their confidence in performing supra-orbital, infra-orbital, mental, and inferior alveolar nerve blocks. Additionally, they found the feedback-enhanced partial task trainer to be extremely helpful for teaching appropriate landmark identification. Our model was successfully used to teach facial and dental nerve block techniques which are able to provide both procedural anesthesia and non-opioid analgesia. Future studies could investigate whether this educational session and model leads to increased competence and/or increased performance of facial nerve blocks in the clinical setting. Topics Nerve blocks, regional anesthesia, dental emergencies, facial trauma.

Section break session, participants are given the opportunity for hands-on skills practice using the task trainer under faculty supervision.
Research Methods: An existing airway task trainer was successfully modified in order to create a feedbackenhanced, partial task trainer for teaching supra-orbital, infra-orbital, mental, and inferior alveolar regional anesthesia. Learners were asked to complete a post-session survey to assess the educational value of the station and the task trainer.
Results: Twenty-one residents (10 PGY-1, 9 PGY-3, 2 PGY-4) participated in a didactic session and all completed a brief post-session survey. Many participants (N=10, 48%) had never previously performed any of these nerve blocks. On average, participants rated their comfort performing these specific nerve blocks before the session to be 1.96 on a 5-point Likert-scale (where 1=not at all comfortable and 5=extremely comfortable). Following the session, participants' comfort level increased to 3.67 on the same scale. Participants rated the usefulness of the feedback-enhanced task trainer to be a 4.71 on a 5-point scale (where 1=not at all useful and 5=extremely useful).
Discussion: Using inexpensive and commonly available materials, we were able to successfully modify an existing airway task trainer in order to create a feedback-enhanced partial task trainer for teaching regional anesthesia of the face and mouth. Learners reported that the educational session greatly increased their confidence in performing supra-orbital, infra-orbital, mental, and inferior alveolar nerve blocks. Additionally, they found the feedback-enhanced partial task trainer to be extremely helpful for teaching appropriate landmark identification. Our model was successfully used to teach facial and dental nerve block techniques which are able to provide both procedural anesthesia and non-opioid analgesia. Future studies could investigate whether this educational session and model leads to increased competence and/or increased performance of facial nerve blocks in the clinical setting.

Linked objectives and methods:
Simulation-based medical education is a widely accepted, effective, and popular modality for teaching both cognitive and procedural skills. Built upon a wide array of educational theories and literature, simulation is an active teaching strategy that not only enhances learning by providing a contextual framework, but also allows learners to process and use knowledge in an engaging way. As described by Bloom's Taxonomy 1 learners can acquire and process information at differing levels. While lectures primarily transmit information and ask learners to remember or recall new information, simulation-based medical education allows learners to demonstrate the acquisition as well as the application of knowledge, both of which represent higher levels of understanding on Bloom's Taxonomy.
Simulation also provides learners with a consistent and safe environment for practice and learning. Whereas the clinical environment is highly variable and instructors cannot guarantee that learners will encounter certain pathology or cases, simulation-based medical education can ensure that all learners are exposed to requisite experiences. Additionally, simulation provides learners with the opportunity to learn and practice skills without introducing additional risks to patients or themselves.
While simulation can be used to teach a wide variety of skills and concepts, it is the ideal modality for teaching low frequency or high-risk procedures. Given the importance of providing anesthesia and appropriate analgesia, coupled with the numerous indications for blocks of the supra-orbital, infraorbital, mental, and inferior alveolar nerves, it is critical that emergency physicians gain experience and comfort performing these blocks. By integrating a positive-feedback mechanism, our task trainer allows learners to perform deliberate practice, either independently or with faculty supervision, while ensuring that they correctly perform the procedure.
Recommended pre-reading for instructor: Time Required for Implementation: The task trainer can be assembled in approximately 30 minutes if a preexisting airway task trainer is available for modification. We recommend each educational session, although flexible, be scheduled for 45 minutes to allow for a brief didactic session and demonstration followed by handson practice. Given that learners may not regularly perform all of these specific nerve blocks in the clinical setting, we recommend including this educational session on an annual or bi-annual basis as part of a standardized didactics curriculum.

Recommended Number of Learners per Instructor:
We recommend a ratio of 1 task trainer for every 4 to 5 learners with a maximum instructor to learner ratio of 1:10.

Objectives:
By the end of the educational session, learners should be able to: 1. Describe and identify relevant anatomy for supraorbital, infra-orbital, mental, and inferior alveolar nerves. 2. Successfully demonstrate supra-orbital, infraorbital, mental, and inferior alveolar nerve blocks using a partial task trainer. instructor spend the first 15 minutes of the 45-minute session reviewing the common indications for these specific nerve blocks, relevant anatomy and landmarks, complications, anesthetic dosing, and appropriate insertion techniques. The instructor should then demonstrate each of these nerve blocks on the task trainer. Following the introduction, learners should practice each of these nerve blocks on the feedback-enhanced task trainer, with the instructor providing feedback and answering questions. At the conclusion of the educational session, the instructor provides a brief recap of the high-yield learning points, as guided by the learning objectives.

List of items required to replicate this innovation:
The feedback-enhanced task trainer is made by using inexpensive and commonly available materials that modify an existing airway task trainer. Many commercially available airway task trainers can be substituted for the base. For each target zone, mold a sheet of aluminum foil around the exposed end of a strand of electric wire.
7. Mold and attach the aluminum foil target to the correct anatomical location on the simulated skull using electrical tape. 8. Repeat steps 5-7 for each target zone. The size of the aluminum foil target can be adjusted for each anatomical location and for the desired level of difficulty. On average, the foil target should be approximately 2-3cm by 1cm, however smaller targets can be used to increase the level of difficulty.
9. Secure the electric wire strands to the simulated skull using electrical tape. It is optimal to tape the right sided strands together into one "cord" and the left sided strands together into a separate "cord."

USER GUIDE
Eyre A, et al. A Low-Cost Facial and Dental Nerve Regional Anesthesia Task Trainer. JETem 2021. 6(2):I1-9. https://doi.org/10.21980/J8RP9Q 6 10. Bring each "cord" to the back of the simulated skull, or wherever they will exit the skin of the airway trainer you selected 11. Carefully return the simulated skin to its original position, bringing it up and over the target zones. Alternatively, you may wish to leave this until the final step to ensure that all electrical connections are working properly.
12. Twist the exposed distal ends of the electrical wire together